Elsevier

Ophthalmology

Volume 105, Issue 12, 1 December 1998, Pages 2313-2317
Ophthalmology

The role of weight loss and acetazolamide in the treatment of idiopathic intracranial hypertension (pseudotumor cerebri)

Presented in part at the annual meeting of the American Academy of Ophthalmology, New Orleans, Louisiana, November 1998.
https://doi.org/10.1016/S0161-6420(98)91234-9Get rights and content

Abstract

Objective

To determine the weight loss associated with resolution of papilledema from idiopathic intracranial hypertension (IIH).

Design

A retrospective study.

Participants

Fifteen consecutive female patients with IIH associated with obesity were studied.

Intervention

Patients underwent weight loss and treatment with acetazolamide during a 24-week period.

Main outcome measures

The severity of papilledema was graded: absent (grade 0), mild (grade 1), moderate (grade 2), and marked (grade 3), based on a predetermined grading system (“gold standard”) using stereoscopic photographs and the Frisén classification.

Results

The 15 patients, with mean age of 31.3 ± 8.8 years, had a mean weight of 110.5 ± 28.7 kg and mean body mass index of 40.7 ± 13.0 kg/m2. Eleven (73.3%) patients had improved papilledema during the 24-week study period, of which 10 (66.7%) had complete resolution of papilledema within a median time of 8.5 weeks. An average of 3.3% weight loss (±0.5% standard error of the mean) was observed among patients having a one-grade change in papilledema. Weight loss of 6.2% ± 0.6% standard error of the mean was associated with a three-grade change in papilledema (i.e., complete resolution of marked papilledema). Nine of the ten patients with complete resolution of papilledema also took acetazolamide. However, none (26.7%) of the four patients without weight loss had improvement in papilledema despite similar treatment with acetazolamide.

Conclusions

Approximately 6% weight loss was associated with resolution of marked papilledema in these authors’ patients. The benefit of acetazolamide in IIH is questioned since weight loss, rather than acetazolamide, appeared to have been the catalyst for reducing the severity of papilledema.

Section snippets

Patients and methods

The records of 48 consecutive patients evaluated within the past 6 years with IIH were reviewed. Fifteen patients from this group met the following enrollment criteria:

  • 1.

    The initial neuro-ophthalmologic evaluation was performed within 10 days of diagnosis of IIH.

  • 2.

    Treatment for IIH was limited to weight loss and use of acetazolamide (500–1000 mg daily) during a minimum study period of 4 weeks and maximum of 24 weeks.

  • 3.

    Only one lumbar puncture was performed, primarily as an aid in diagnosing IIH.

  • 4.

Results

Table 1 provides a summary of patient data. All 15 patients were women with a mean age (±standard deviation) of 31.3 ± 8.8 years, ranging from 19 to 48 years. The mean weight was 110.5 ± 28.7 kg, ranging from 79.6 to 208.6 kg. The mean body mass index, calculated by dividing the weight in kilograms by the square of the height in meters, was 40.7 ± 13.0 kg/m2, ranging from 29.6 to 86.9 kg/m2. All patients were obese as defined by body mass index greater than 26 kg/m2.12 There was 100%

Discussion

The study documented the beneficial effect of weight loss in the treatment of IIH. Eleven (73.3%) of 15 patients had improved papilledema within the 24-week study period. Indeed, 10 (66.7%) of the 15 patients had complete resolution of papilledema within a median time of 8.5 weeks. The visual function similarly improved or remained normal in all patients with resolution of papilledema. The study identified that among the patients with a one-grade change in papilledema, a mean weight loss of

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Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York, to the Mason Eye Institute of the University of Missouri-Columbia.

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